Children who have been adopted at an age older than newborn frequently struggle with self-esteem issues. They may come across as if they are superior to everyone they encounter including family members. Is that really a mask for a fragile self-esteem that is vulnerable to even the slightest criticism? People who suffer from a mental disorder called Narcissistic personality disorder have a deep need for admiration and an inflated sense of their own importance. While initially, you may think that the older adopted child suffering from a narcissistic personality disorder has healthy self-confidence and self-esteem it may soon become obvious that your child has crossed a fine line. People who have healthy self-esteem tend to value other people and their relationships as much as they value themselves. Those with a narcissistic personality disorder seem to put themselves on a pedestal.

Having a personality disorders tends to limit a persons ability to function in relationships, work, or school. Those who suffer from a narcissistic personality disorder tend to display dramatic and emotional behavior. They tend to come across to others as conceited, boastful, or pretentious. They may monopolize conversations even the ones in which they were not initially included. They may think that they should have the very best of everything and receive special treatment. They may become angry when they don’t receive what they feel they are entitled to receive. Some complications of an untreated narcissistic personality disorder may include substance abuse, alcohol abuse, depression, suicidal thoughts, eating disorders, particularly anorexia nervosa, relationship difficulties, problems at work or school.

Narcissistic personality disorder symptoms may include:
 Believing that you're better than others
 Fantasizing about power, success and attractiveness
 Exaggerating your achievements or talents
 Expecting constant praise and admiration
 Believing that you're special
 Failing to recognize other people's emotions and feelings
 Expecting others to go along with your ideas and plans
 Taking advantage of others
 Expressing disdain for those you feel are inferior
 Being jealous of others
 Believing that others are jealous of you
 Trouble keeping healthy relationships
 Setting unrealistic goals
 Being easily hurt and rejected
 Having a fragile self-esteem
 Appearing as tough-minded or unemotional

Underneath the grandiose behavior often lies a fragile self-esteem. Anything that seems like criticism may be difficult to handle and the person may have a secret sense of shame or humiliation. Reacting with rage or contempt may make a person with narcissistic personality disorder feel better. Most mental disorders have complex causes and that is likely true with narcissistic disorder as well although the exact cause is not known. Perhaps a dysfunctional childhood causes the disorder. Some suggested causes include overindulgence, overvaluation, expectations that are too high, abuse, neglect, or genetics.

To be diagnosed with narcissistic personality disorder, you must meet criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental conditions and by insurance companies to reimburse for treatment.
Criteria for narcissistic personality disorder to be diagnosed include:
 Having an exaggerated sense of self-importance
 Being preoccupied with fantasies about success, power or beauty
 Believing that you are special and can associate only with equally special people
 Requiring constant admiration
 Having a sense of entitlement
 Taking advantage of others
 Inability to recognize needs and feelings of others
 Being envious of others
 Behaving in an arrogant or haughty manner